ABSTRACT End stage kidney disease (ESKD) is a complex disease with individuals having variable life- expectancies, with 25% dying within 1 year and 41% surviving at least 5 years. While providers recognize that patients are different ? and ought to be differently ? there are no tools to reliably forecast individual life expectancy and aid in treatment individualization. Instead, providers are left with often unclear or incomplete guidelines on how best to manage patients. In order to provide precision care for patients on hemodialysis (HD), there is a critical need to be able to (1) dynamically assess life expectancy for medical decision-making; and (2) identify distinct clinical phenotypes to enhance clinical monitoring and care planning. Our central hypothesis is that there is heterogeneity in patient survivorship and disease trajectory that, when known, can be used to provide more personalized and effective care. By coupling novel machine learning approaches for survival prediction with granular clinical data on HD patients, we will be able to develop the analytic tools necessary to support precision care. At the completion of this proposal we will have tools to dynamically assess a patient's life expectancy and insights into heterogeneous disease phenotypes for patients with ESKD. These tools will allow providers to make informed treatment decisions as well as lay the groundwork for further precision research into optimized patient care.